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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 NOR7y BUILDING PERMIT 04 6�ti .Z yFr`ii..may-s6 Q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION jK _ Permit No#: a' Date Received �,,ySpgAT60 SAC lu`r Date Issued: IMPORTANT Applicant must complete all items on this page LOCATION � . ii?nn# PROPERTY Dl1UNER ' Pent 10Yeartruc#ure yes na MAP PAROL ZONING DISTRICT Histartc Drstnct yes no ` Machine SFap 1/i[lage Ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �K One family ❑Addition ❑ Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement F1Assessory Bldg ❑ Others; ❑ Demolition Other IY�S ❑ Septic ❑.Well ❑ Floodplain C7 Wetlands © Watershed Dtstrtct`` ❑Water2Sewer DESCRIPTION OF WORK TO BE PERFORMED: C.--c- v OCA Identification- Please Type or Print Clearly OWNER. Name. F'C�-W1 r Phone: - Address: Contractor Name_1 � t� t� cC� cwe' � � , t ?hone. "1 - Erriatl c r C�.4 i Address.;; 5upervtsor's Constructton'Ltcerise. CS - , Exp ; Date': I I Home Impro�emenfi License s 0 (D Exp. ; Date`. _# ARCH ITECTIENG[NEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �,� �� � .�� FEE: $ Check No.: �' Receipt No.: 12- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Gn 9ature of A ent/Owner Signature of contractor --_ __ _ - —. 9 _ : -- ......................... ........... .......................................................... 'T NORTH own of . "N Andover. No. C, LAKE h ver, Massj ':0C IcKeWSCK ArEo BOARD OF HEALTH Food/Kitchen P E LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... . ....... .... .. .. ........ .%.jN.............. has permission to erect .............. ......... buildings on .... SfAVk%-- - -1 If 0 1.2k......... Foundation 400 ..... ....... ...............................................I.—... Chimney to be occupied as .............. ... .. . ....... Rough provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of t.he Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ................. Final ...i [logo... "4BtU!ILDIirNGINSPECTOR UNLESS CONSTRUCTI Rough Service ............... . .... .... GAS INSPECTOR Occupancy Permit Rmired to Occupy Building Rou'gh Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. I RISE 00 ahawmut toad, Unit 2 Canton, NIA 020211339-502-6335 ENGINEE6;1NG www.RISEengineering.com _ .. (Owner's Dame) owner of the property located at: 725 (Property.Address) (Property Address) an Merrimack Valley insutation 23A Suitivan Rd hereby authorize Billerica,MA Q1©62 mm (Subcontractor) an authorized subcontractor'for RISE Engineering, to acton my behalf to obtain a building permit and to perform work on nay property, This forma is only valid with a signed contract. `her Permit w€il be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. �w 1 "s Signature Date 62016 | � | for cligible nicamines,Columbia Gas ofl'eri 7P�')incentive,not to exceed S2,000 per calevidaryear,and an incentive kit'100%for ! Fadoral ID 0 06-0405629 RUSE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 F CT Contractor Registration NO RISE (All ShAIA Inut Road,Canton,MA ENGINEERING; CONTRACT 1401)784-3700 F%X(401)784.3710 Page 2 PROGRANI Tfp3 CopjTRACT M WrEAV)04TO TfEnvEcu FUSE CNIA-11ES ERGWEERWO AND WE CUSTOMER FOR Y"S A'S 04SCRWOVELOV0 CUSTOVO4 PRO04C DAIL CUENT I WORX ORDER Paul Diorio (978)886-11,11 09(26,12016 414900 35003 SERVICE STRECT U4,04C,STREET 3 125 Surniner Street 325 Surmner Street SCRWCF C",SrATE.VP DGLLINO CITY,STATE,ZIP '."~Furth Andover, M A 01845 North Andover,MA 01845 JOB DESCRIPTION a7 he C of off r heat I ngs)s teu)and Is aterheater Inwit1w is$3,110 SQ000 F r 0 `E, ("s, E. V E*IE ........... Total: $2,466.56 Program Incentive: $2,075.55 Customer Totak $391.01 WE AGREE IIEREBY TO FURNISH SERWCES-COMPLETE IN ACCORDANCE WTJ1 ABOVE St1ECflCAWNS FOR IRE SUM Of "'Three Hundred Ninety-One&011100 Dollars $391.01 CFOiN FMAL WSPEC"04 ANO APPROVAL By f�jvl�f 0404,E11041G.CUSTOMOFft AS�JEL&Y(j REWT&MOI;NT nUE ai t ULL.WTFW7,r OF'1%YM L 0L C"t6rn WNTHLY GN ANY UNPAYOBALAW�EWFRZOVAYZ 9PEREVERSEF Oft IMPORTANT 0&UHMATtON ON 0��ARANTEUS,R.,GHT3 OF RLCrSHON,S01LOUL,`40�WD CW4tKAGIOR 9Fr'Z'RAT W'N 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAPW SPACES IX, tllA�_,_-) / AUTIRgwvto slanATuRE_tvu Ew;�.-mj !CfPTNsCL VA1EoFACCfPTANCL ACC L 0ANC L Of Go 04 7 RAO I-THE AU0VF PA C*S,SPECI F ICA1 IONS W3 CtWXRORS ART. SAT I S W3TORY 10 US AY4 0 ADE d A RE UY ACCEPT[O.MOD ARG,AU 1)10 RV.E 0 TO DO THE%W4 K DAYS A.NPrClX0 MERRVAL-03 WEJE DATE(MAi'AIDD)YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTETUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE BOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileo ofsuch endorsement(s). PRODUCER CONTACT NAME. Automaft Data Processing Insurance Agency,Inc PHONE — - FAII 1 ADP Boulevard c No Ext� Arc,No -MAIL Roseland,NJ 47468 ADDRESS: JNSURER(S)AFFORDINGCOVERAGE NAIGO )NSURERA:5Star W AAIG Arnerican Alternative lr)suran. INsilREa Merrimack Valley Insulation Cors .. INSURERS: 23a Sullivan Rd INSURERC: North l3fllel'ica,MA 01862 INSURER D: ----------------- - — ----------- — INSUR_ER E INSURER F--. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CePTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERWO INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 6VHlC1I THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBeD HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDFFIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR- F 7 7 --- .--._TYAt;OFINSURANCEINSR SWVni v -POLICY NUMBER _���I h1�DllIYYYY l hS�ID�YYYY I ..� --- )IhlrrS GENERAL LIABILITY EACH OCCURRENCE j S OAMAUL 10 KEN GOMll.1ERCIALGENERALUAHILITY = — CtAffiS-IAAOE OCGuP. { MED EXP(Anyanzpersvn)_ I5- ---.-F_- ---- -.-- S PERSONAL&AOVINJURY _j5_ E i :GENERALA_GGREIGAI_E S GEN'LAGGREGATEUMITAFPLIESPEM ! PRODUCTS-COMPIOPAGG 5 i POLICY i ;.PiEC n LOC } - 5 S AUTOMOEILE LIABILITY f i }OCINiS1NEOSINGLE UMir l I Ea accident ANY AUTO i BDAILY INJURY(Pcrperson) S AUTOS NED ACHEDULEO i i ;8001LYiNJURY(Peracdiienl)I SUTOS ( NON OWNEDI I i PROPERTY DAMAGE 5 HIREQ AUTOS AUTOS Peraecrders i UMRRELLA LIAR OCCUR ' EACH OCCURRFNCE EXCESS LJAS CLAIMS-NINDE) AGGREGATE 5 - � DEE) I I RETENTIQNS � � ----..----__--�---- $ WORKERS CONWENSAITON ) WC STA OTH- AND Eh1PLOYERS'LIABILITY JA ANY PROPRIEi-ORIPARINERtEXECUT(VE Y®fN N f A Lr9)1VC749118 611812416 611812417 E.L EACH ACCiOENFS 1,000,000 OFFICEMIEIIBEP.EXCLUDED? — — — j{fiAaadotocyinNN} EA-DISEASE-EA EMPLOYE s 1,004,444 if qqes,describe ander — --�— OE6CRIPTION OFOPERFiTIONFSbP;6sv E.L.DISEASE-POLICYWAIT $ '1,400x1300 I DESCRIPTION Or OPERATIONS I LOCATIONS VEHICLES(Attach ACORD 101,Additional Remarks Schedule,irmorc space is fequitad) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POL mem BE CANCELLEO.BEFORE THE E"IRAMN DATE THEREOF, NOTICE WILL. BE DELIVERED IN Town of North Andover,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 124 M ain Street THORIZED REPRESENTATIVE North Andover,MA 01845 I I - O 19882010 ACORD CORPORATION. All rights reserver}, ACORD 25{2010105} The ACORD name and logo are registered.marks of ACORD 0 DATE(MMODIYYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 11107/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Carolyn A Coughlin Charles J Coughlin Insurance PHONE (97$)957_358B IFAX No 14 Dinley Street c O E : P.Q.Box 10 E-MAJL carolyn@coughlinitis.com ADDRESS: Yn@cou g Dracut,MA 01826 INSURERS)AFFORDING COVERAGE NAIC If INSURERA: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURER C: Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 __._. ... INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJFCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICYNUMBER MMIDD MMMD INSR - _m.. ADDL SUBR POUGYEFF POLICYEXP LIMITS LTR A COMMERCIAL GENERAL LIABILITY WS274182 01/21/2016 01121/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F2 CCCUR PREMISES 4Ea occurrence $ 100'000 MED EXP(Any ane person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENLAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000,000 S/ POLICY ]PRD-JECT u LOC PRODUCTS-COMPlOP AGG $ 2,000,000 __..._..._ OTHER $ B AUFOMOBILELWBIL[rY 6205006 1112512495 31/25/2016 Ea cOMBINEDSINGLELIMIT $ 1,000,000 _ acCi,. W ANY AUTO BODILY INJURY(Per person) $ ._............I-..—._OWNED / SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY V AUTOS HIRED / NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY V AUTOS ONLY Per acddenl UMBRELLALIAB OCCUR 87593L161ALI 09/21/2016 01/21/2017 EACH OCCURRENCE $ 3,000,000 ExCESSLIAs CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $0__._........ $ WORKERS COMPENSATION AND EMPLOYERS'LMaBIL€TY YIN STATITIE ER ANYPROPRETORIPARTNERA=XECUTiVE E.L.EACH ACCIDENT $ OFFICEWMEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ._._._,._,_...._,_...., ...W,�......,._._,__.._._....._,_,. OFSCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached If more space Is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andoer,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ' ' C/A(D (Y ,/ff Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor Registration Type: Corporation r .� Registration: 180506 Merrimack Valley Insulation Carp.; Expiration: 11/23/2018 23 A Sullivan Rd ' Billerica, MA 01862 Update Address and return card. Mark reason for change, scA1 t`a zaM•a.,Pit F],Address,_f .Retis!!!m! f""1.Employment 0,1_rz9trarra (��',/✓YC" t(Lx Y/t IIlI01[/(!('(/�/Cft(��'P�(I,(,1;P(!CF/If,1C'f�5 a Office of Consumer Affairs&Business Regulation � NOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. If found return to: t Registration Expiration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 y, i 60506 11/23/201 f3 Boston,MA 02116 Merrimack Valley Insulation Corp Joseph Ryan 23 A Sullivan Rd .�' GQ — Billerica,MA 01862 �- Undersecretary Not v41id ithout signature 7 • t�@assa,@1uso� iaot,is a�*��nt as i�uT�t¢c Swttfew F Board or sui@dinr wegz i :, r and s '1rdr; 6A Ci6�Ldi@1C ."kE�l{ l s'ubA a �fl / oa se CS-075541 JOSE,PH A RYA,r� 200 King Rail Dr:Apt'201 � _ Lynnfield MA 017940 52-� 07Ja41za17 ° The Commonwealth of Afassachtisetts Department of Industrial Accidents Office ol'Investigations � y 600 Washington Street "r` Foston, A11A 02111 www.irass.gov/rlea Workers' Compensation Insaarance Affidavit: Builders/Contractors/ElEl lectit icians/Phimbers iWolicant Information Please Print Legibly Nate (Btasiness/Orgat,ix..atinn/lndividtaal): Merrimack Valley Insulation Corp. ------- Address: 2.3 A Sullivan Rd. C"i.ty/State;/Lip:,_Billericay.MA 01862 ._.._ _..._.,....._ _ Phorle Vii: 978-388-3495 Are you an employer`!Check the appropriate box: Type of project(required): 1.FK I ant a employer.with18 4. n 1 am a general contractor and l .___.. have hired the sub-contractors ❑ New cortstrttc tion employees (full and/or part-time).* 2.0 1 am a sole proprietor or Partner_ listed on the attached sheat. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition. [No workers' comp. insurance comp. insurance.t 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercise([their 11.❑ Plumbing repairs or additions rayself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] IF c. 1.52, §1(4), and we have no employees. [No workers' 13.© Other Insulation comp, insurance required.) 1°Any applicant that checks box#1 raanst also fill oot the scetion below showing their workers'compensation policy intonnation. Honacowners who submit this affidavit indicating they are doing;all work and then faire outside contractors must submit a new affidavit indicating,such. ^C"ontr.actons that check this box anUst attached an additional sheet showing the name of the sub-contractors and state whether or not those entities;have employees. If tlic sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insui-ancefor my einl4oyees. Below is the policy and iob site information. Insurance Company Name: 5Star V3 AAIC American Alternative Insurance Policy p or Sell-ins. Lic.t#: V9WC749118Expiration Date: 6/18/2017 ...__.._. lob Site Address: 3` Y,--Y _._ _._... .. ........... ip:h ,ttYcEc�e.r lyl, fi.i .'4, ,attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration slate). Failure to secure coverage as required tender Section 25A of MG1.,c. 152 can lead to the imposition of criminal penalties of a .tine up to$1,500.00 and/or one-year imprisontn.ent,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of tel]to$250.00 a clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I rip her-eby certify under the pains arrr!perzralties g0erjuq that the information provided above is true and correct, Signature: ,. Phone#: 8-888-349 (ficial use,only. Do not tvrile in this area,era be corrrpleled by city or town official. City or`.['own: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5.Plumbing Inspector 6. Other. Contact Pet-Sol): Phone##: _ J Th e COxomvaaIt 1otf AT--Sia-2hu9e�s 600 W.-Lg[ii ro):St . oston' s'&' 021111 _rlaleg.g,-EVid.ja ?213�i?E't©ri LTL 1'.ai3Hd[ �s/Co T LorS!�'ijeCi£ECi S�ls� Et2rs r ppI�caiia t ufor�n o —?7lea.se i'rjvt 3 n� by esu^= Cztyd•S Ease 2:43_`Ib 11 Phone I --LeTop- an employer' ._reyou e hOmmeOTper' ClAIac fie Q rO a a_e nye _ . an a_ a nnlo�erwi�j icy�s[ :'or i ire, i am a sola proprIctur or parr r[ex Iiaa&�a�'a no employ-ecs woridigg nor Tae la ani'capac€t=. 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Board o�MmVdi '`_P_uH IiRg Den_ 3- vi','?�':i:':ft i:;erk - BIz:1;Li+2F lmsp. - _PEU_TYEb it.Ga. �`an�ac_pat�ar_ €grind "tona